Forms

This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.

NMSIIS Decision to Remove Record (Spanish)

Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.

NMSIIS User Security and Confidentiality Agreement 2024

This form may be used by individuals requesting a religious or medical exemption to immunization for their children whom attend any public, private or parochial pre-school, kindergarten, elementary, secondary school, or home school and for children attending daycare of childcare facilities.

Certificate of Exemption FAQ

This form may be used by individuals requesting a religious or medical exemption to immunization for their children whom attend any public, private or parochial pre-school, kindergarten, elementary, secondary school, or home school and for children attending daycare of childcare facilities.

This form is used by a patient/parent/legal guardian to decline to participate in the New Mexico Statewide Immunization Information System.

NMSIIS Decline to Participate (Spanish)

County: Bernalillo

Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union

Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro

The New Mexico VFC Program requires each practice to develop and maintain a Routine Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement for VFC Program participants to have written vaccine storage and handling plans.

The New Mexico VFC Program requires each practice to develop and maintain an Emergency Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement to have a written plan for storage and handling procedures in an emergency.

Adult TSR Form

VFC Provider Staff Change of Contact and uploading Training

VFC Physician Signing Agreement Change of Contact

All VFC providers are required to submit this annual VFC certification form in order to continue receiving VFC vaccines.

VFC Instructions on Digital Signature and Attaching License

This form allows providers to order VFC supplies.

Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.

NMSIIS User Security and Confidentiality Agreement 2023

COVID-19 Vaccine Troubleshooting Report

This is the form to be completed by parents or guardians indicating whether or not a child is to be vaccinated at school.

VFC School Immunization Consent Form (Spanish)